Serial plasma procalcitonin levels in patients requiring admission to liver ITU with paracetamol induced acute liver failure

Jackson, Neil; Batouche, S.; Sherwood, R.; Wendon, J.

doi:10.1093/bja/84.5.692

Cited by 3 publications

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“…While baseline PCT values increased as the severity of the underlying liver disease increased, an elevated PCT was indicative of bacterial infection. A previous study of PCT use in ALF patients due to APAP toxicity also showed increased PCT values in subjects without evidence of bacterial infection [ 14 ], similar to our findings.…”

Section: Discussionsupporting

confidence: 91%

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Procalcitonin Identifies Cell Injury, Not Bacterial Infection, in Acute Liver Failure

et al. 2015

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BackgroundBecause acute liver failure (ALF) patients share many clinical features with severe sepsis and septic shock, identifying bacterial infection clinically in ALF patients is challenging. Procalcitonin (PCT) has proven to be a useful marker in detecting bacterial infection. We sought to determine whether PCT discriminated between presence and absence of infection in patients with ALF.MethodRetrospective analysis of data and samples of 115 ALF patients from the United States Acute Liver Failure Study Group randomly selected from 1863 patients were classified for disease severity and ALF etiology. Twenty uninfected chronic liver disease (CLD) subjects served as controls.ResultsProcalcitonin concentrations in most samples were elevated, with median values for all ALF groups near or above a 2.0 ng/mL cut-off that generally indicates severe sepsis. While PCT concentrations increased somewhat with apparent liver injury severity, there were no differences in PCT levels between the pre-defined severity groups–non-SIRS and SIRS groups with no documented infections and Severe Sepsis and Septic Shock groups with documented infections, (p = 0.169). PCT values from CLD patients differed from all ALF groups (median CLD PCT value 0.104 ng/mL, (p ≤0.001)). Subjects with acetaminophen (APAP) toxicity, many without evidence of infection, demonstrated median PCT >2.0 ng/mL, regardless of SIRS features, while some culture positive subjects had PCT values <2.0 ng/mL.Summary/ConclusionsWhile PCT appears to be a robust assay for detecting bacterial infection in the general population, there was poor discrimination between ALF patients with or without bacterial infection presumably because of the massive inflammation observed. Severe hepatocyte necrosis with inflammation results in elevated PCT levels, rendering this biomarker unreliable in the ALF setting.

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Section: Discussionsupporting

confidence: 91%

“…PCT has been examined in patients who have had a liver transplant and in patients hospitalized with chronic liver disease (cirrhosis; CLD), but there are few studies of patients with ALF. [ 9 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

Procalcitonin Identifies Cell Injury, Not Bacterial Infection, in Acute Liver Failure

et al. 2015

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“…Consistent with our results, Jackson et al. found high PCT concentrations in acetaminophen‐induced ALF [median value, 9.4 ng/ml (0.9–123.8)] 30 . Similar cases were recently published 31 .…”

Section: Discussionsupporting

confidence: 92%

“…29 Consistent with our results, Jackson et al found high PCT concentrations in acetaminophen-induced ALF [median value, 9.4 ng/ml (0.9-123.8)]. 30 Similar cases were recently published. 31 Moreover, Mallet et al reported significantly higher PCT concentrations in acetaminophen-induced ALF than in any other causes (10.6 vs. 0.8 ng/ml p < 0.0001), irrespective of any concurrent infection (10.3 vs. 10.7 ng/ml, p = 0.7).…”

Section: Discussionsupporting

confidence: 91%

Plasma procalcitonin may be an early predictor of liver injury in acetaminophen poisoning: A prospective cohort study

et al. 2021

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Background and Aims Acetaminophen is a common cause of poisoning and liver injury worldwide; however, patient stratification is suboptimal. We aimed to assess the contribution of admission plasma procalcitonin concentration (PCT) to better identify acetaminophen‐poisoned patients likely to develop liver injury. Methods We conducted a prospective observational cohort study including all acetaminophen‐poisoned patients requiring N‐acetylcysteine admitted in a toxicological intensive care unit between 2012 and 2017. Multivariate analysis was performed using a Cox regression model to investigate factors associated with liver injury, defined as an increase in alanine aminotransferase (ALT) >100 IU/L. Results One hundred seventeen patients (age, 32 years (21–53), median [25th–75th percentiles]) were included after self‐ingesting 16 g (9–30) acetaminophen and received N‐acetylcysteine infusion administered within a median 6 h‐delay (4–12) from exposure. Co‐ingestions were reported in 77% of patients. Rumack–Matthew nomogram was non‐interpretable in 47% cases. Liver injury occurred in 38 patients (32%) with a median peak ALT of 2020 IU/L (577–4248). In liver injury patients, admission PCT was significantly increased in comparison to patients without liver injury (21.5 ng/ml (3.2–44.9) versus 0.1 ng/ml (0–0.4), respectively, p < 0.01). The increase in PCT preceded the increase in ALT by 33 h (10–74). In a multivariate analysis, PCT > 1 ng/ml was significantly associated with liver injury (hazard ratio, 7.2 [95% confidence interval, 2.3–22.6; p < 0.001]). PCT (area under the receiver‐operating characteristics curve, 0.91 [95%CI: 0.84–0.97]) predicted liver injury with sensitivity, specificity, negative, and positive predictive values of 0.92, 0.84, 0.96, and 0.73, respectively. Conclusion PCT on admission is associated with liver injury in acetaminophen poisoning. PCT might be used as a predictive tool of liver injury to improve clinical decision‐making.

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Undue Elevation of Procalcitonin in Pediatric Paracetamol Intoxication is Not Explained by Liver Cell Injury Alone

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Felderhoff-Müser

et al. 2018

Annals of Hepatology

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Serial plasma procalcitonin levels in patients requiring admission to liver ITU with paracetamol induced acute liver failure

Cited by 3 publications

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Procalcitonin Identifies Cell Injury, Not Bacterial Infection, in Acute Liver Failure

Procalcitonin Identifies Cell Injury, Not Bacterial Infection, in Acute Liver Failure

Plasma procalcitonin may be an early predictor of liver injury in acetaminophen poisoning: A prospective cohort study

Undue Elevation of Procalcitonin in Pediatric Paracetamol Intoxication is Not Explained by Liver Cell Injury Alone

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